Obviously it’s pleasing to see, in the storm of commentary over Professor Nutt’s sacking, that everyone outside of politics now recognises the importance of scientific evidence in devising laws. But a strange reasoning twitch has appeared, in the arguments of politicians and right wing commentators. Science can tell us about the molecules, they say, about their effect on the body, and the risks. But policy is a separate domain: a matter for judgement calls on social and ethical issues. Only politicians, they say, can determine the correct way to send out a clear message to the public. It is not a matter for science.

Interestingly this is wrong. Alongside research into the risks of drugs, lots of research has also been done examining the deterrent impact of different laws, classifications, and levels of enforcement. Since every piece of research has its own imperfections (and nobody has yet conducted a randomised controlled trial on drugs policy) you can make your own mind up about whether you find this research compelling.

One strategy is to compare different countries. A World Health Organisation study from 2008, published in the academic journal PLOS Medicine, compared drug use and enforcement regimes around the globe. It was clear: “globally, drug use is not distributed evenly and is not simply related to drug policy, since countries with stringent user-level illegal drug policies did not have lower levels of use than countries with liberal ones.”

Alternatively you can compare drug use between states within one country, if they have very different enforcement regimes, as happened when some parts of the US liberalised their laws a few decades ago. In 1976 Stuart and colleagues found that cannabis use in Ann Arbor, Michigan, wasn’t affected by reductions in cannabis penalties, when compared with three neighbouring communities which kept penalties the same. In 1981 Saveland & Bray looked at national drug use surveys from 1972 to 1977 and found that cannabis use was higher in the ‘decriminalised’ states, both before and after the changes in law, and when they looked at rates of change, although cannabis use was increasing everywhere, the most rapid increase was actually in the states with the most severe penalties. In the same year Johnson and colleagues used survey data on high school use and found decriminalisation had no effect on attitudes or beliefs about drugs. These studies are old, of course, but only because the liberalisations in the law which they rely on for data happened a long time ago.

Another line of evidence comes from “before and after” studies, when laws are changed. Cannabis use in the UK dropped, of course, after cannabis was moved from class B to class C. Prohibition of alcohol in the USA from 1920 to 1933 is the most famous example: here, alcohol use fell dramatically when prohibition began, and the price of alcohol rose to 318% of its previous level. But by 1929, this initial impact had begun to wear off, and rapidly: alcohol consumption had risen to 70% of pre-prohibition levels, was still rising when prohibition was repealed, and the price had fallen to only 171% of pre-prohibition levels. Notably, this reversion to old patterns of use occurred despite escalating expenditure on enforcement, which rose by 600% over the same period. There are many more examples.

This is not an unresearchable question. It is clear that there are many other factors at play in all of these studies, and if they are not sufficiently rigorous for the government, or a brief informal dip into the literature is not enough (it shouldn’t be) then they should commission more formal research: because it is a basic tenet of evidence based policy that if you discover a gap, you flag it up, and commission more work to fill it.

This is important for one simple reason. If you wish to justify a policy that will plainly increase the harms associated with each individual act of drug use, by creating violent criminal gangs as distributors, driving the sale of contaminated black market drugs, blighting the careers of users caught by the police, criminalising 3 million people, and so on, then people will reasonably expect, as a trade-off, that you will also provide good quality evidence showing that your policy achieves its stated aim of reducing the overall numbers of people using drugs.

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74 Responses

JohnK said,

So why do politicians continue down the prohibition route when it’s plainly wrong in all the ways you eloquently lay out in the last paragraph? People often say it’s due to fear of bad press (soft on drugs) or pressure from big-backy and big-booze. I think it’s more personal than that; no matter what they do, the people ignore them and do as they wish. Imagine how much a politician hates that. It’s intolerable, they haven’t spent their careers climbing the greasiest of poles only to find that they can be ignored. So they press on. We will listen to them. We will.

smowton said,

The odd thing is, suppose a Labour government said to hell with it, let’s legalise the less harmful drugs (cannabis, ecstasy, LSD, …) and tax the resulting industries to pay for the inevitable casualties, like we do with tobacco and alcohol. Then the Daily Mail would certainly stir up a storm, but how many Daily Mail readers were Labour voters to begin with? And after the storm wears off, how much lasting impact will it really have? In short, should they really care?

By contrast a Conservative government would have much to fear from reasonable evidence-based drugs policy, as their voters are to some degree Mail readers, so the window for admitting reason is unfortunately closing.

quietstorm said,

So how much should our politicians be our representatives, and how much should they be responsible to make their decisions based upon new evidence which may be counter-intuitive to many of their electorate?

I am 100% behind evidence-based policy making, but I feel it raises an important question – when should our MPs lead us, and when should they represent us?

nongovernmentalindividual said,

See this story for yet another angle: about how liberalisation of drug cultivation in the US has created competition for Mexican growers and potentially reduced violence. tinyurl.com/ybrymca.

While I agree with the conclusions in Ben Goldacre’s article, I want to play devil’s advocate a bit. I think that part of the issue is not only that policy makers disagree on how to tackle an issue, but also that they disagree on what the desired outcome is. Ben Goldacre cites the “stated aim of reducing the overall numbers of people using drugs”. But is that it? I’m sure on the floor of the house of commons MPs are talking about all sorts of aims, such as reducing deaths, morbidity, getting rid of gangs, “cleaner streets”, reducing costs to the NHS, etc etc. Many of these may have an element of moral panic and not be based on very robust data either. And politicians are almost certainly looking to find vote-winning formulas. But I think it is important to at least concede that different people want different results.

Take criminal justice as another example. What are the aims of locking someone up (or executing them)? To punish them? To stop them reoffending? To get revenge? As a deterrent to others? Opinions vary widely not just in regard to the rights and wrongs of the aims, but also in regard to the rights and wrongs of each type of response. I’d guess that the death penalty goes some way to fulfilling most of the criteria above, but I’d hope that policies on execution continue to be informed with reference to “social and ethical issues”.

So when politicians argue for a given approach on the grounds that “it works”, I always wonder to myself “works to do what?”. Scientific research (of which I am both a fan and a consumer) can only evaluate the effectiveness of policies in relation to defined endpoints, but if we can’t evaluate every single endpoint, or if different policies are effective in achieving different desired outcomes, then I’m not sure science can always provide the answers. But unfortunately this also means politicians can and do move the goal posts.

Politicians at ministerial level tend not to care if policies work, they tend to care about whether the policy will gain them votes or get favourable press coverage.

For some reason politicians believe that any policy except “be tough on drugs” is a vote-loser and will get unfavourable press coverage. They even seem to believe that having a sensible debate about drugs policy will make them seem weak. These beliefs are not-evidence based.

To justify a policy you not only need to provide good quality evidence that it achieves its stated aim, you also need to show that the electorate agrees with the policy, the aim, and the trade-offs required to achieve the aim.

Martin said,

RickBe said,

Why do politicians of all parties continue in their stance against drugs? It could be that they believe they are responding to the will of the people. But public opinion should not be their only consideration; politicians went against perceived public opinion when they abolished the death penalty. Politicians as a group have invested decades of their lives in fighting a phony war against drugs in society. They have wasted billions of public money on police, courts, prisons and publicity. They have damaged millions of innocent lives of people who were found with drugs. These victims of society were not harming others; it has now been revealed that they were not harming themselves either. And I would guess that quite a proportion of these politicians are hypocrites as well; they tried drugs at some point and chose not to use them again, but now continue to toe the political party line. So the question for politicians is how they are going to back-pedal and restore common sense to the laws of the country; laws that cannot be justified and are extremely damaging for the society they are intended to protect. If there is one trait that best characterises politicians is that they are very keen to ‘save face’…

adamk said,

Though a firm believer in the decriminilisation of illicit drugs generally , I can see their point.
Studies and research have enough difficulty cutting out confounding factors , and producing reliable evidence for relatively simple hypotheses such as – drug A leads to outcome B. The reliability of research into such complicated questions as to the effect of prohibition on a soceity has to be questioned.
There are limits to evidenc based research!

enzyme said,

But policy is a separate domain: a matter for judgement calls on social and ethical issues.

What the right-wing argument fails to take into account is that “ethics” is much richer than the screaming of the tabloids. Ethicists – or those worth their salt – listen to the factual evidence, and proceed from there. It’s not a matter of choosing between facts and ethics, or scientists and ethicists. For sure, an ethicist may consider more than the bare facts – he’d have to, the fact/ value distinction being what it is – but that doesn’t mean disregarding or discounting evidence. And what ethicists and natural scientists have in common – that we ditch our hunches if the evidence (both factual and argumentative) is contraindicative – is much more important than what is different.

Thus, adamk (#11), you’re right: there are limits to evidence based research. But noone in their right mind would deny this.

Trust me. I’m an ethicist.

crustygit said,

Not only drug laws apply to their use. I lived in California in the mid 70’s where dope speed, coke, uppers, downers, quaaludes, acid etc were heavily used by – as far as I could tell – all young people under 21. When I asked why, they said it was because they couldn’t buy alcohol till they were 21 and drugs were easier to get. Interestingly, drug use is also very high in Italy where public drunkeness is despised. The rule seems to be that young people will take whatever they can most easily get high/drunk on!

You are quite right that changes to drug policy are themselves amenable to an evidence-based approach, but the impression I get is that not enough evidence has been gathered yet. Society is an extremely complex system, and the effects of attempts to change it via policy can be both unintended and irreversible. This argues in favour of a cautious approach to policy making: even if there is firm evidence of minimal physical harm from drugs, we must be sure that the benefit outweighs the risks to society before we act.

Having said that, I agree that sacking Professor Nutt was the wrong decision. I don’t see how attempting to suppress the expression of valid and pertinent facts is in anyone’s interests.

Jonny said,

Why are politicians (and the Mad Mels) so hung about over the “moral” aspects of drug taking ? I don’t get that bit at all. I remember a senior officer from the Met ranting to the (London) Evening Standard about the immorality of middle-class drug users, and how the full force of the law would rout these immoral scourges of society!! It wasn’t a coincidence that this bloke was reported as being a born again christian.

As Prof Nutt pointed out many sports are more dangerous than popping and E. Shouldn’t we ban sky-diving and freestyle climbing ? These activities strike me as particularly wreckless and selfish.

Didn’t drug (heroin) addiction begin to spiral out of control when legislation finally closed down the the last avenue for addicts to get a regular fix from their GPs in the early seventies ? I need to read Richard Davenport-Hine’s book again … a very revealing read about the history and drivers behind prohibition.

ghizlane said,

Since I don’t know all the details of this particular case and many others posted in this website (because I am from overseas) – though I am as concerned by the problems and debates going on here- I a going to talk from the logics and principles at the bases of them (or at least how they appear to me being so).

I don’t think the problem is about which domain gets to be in top of which (politics having authority over science or the opposite science having custody over politics), but instead, it is about how two different domains (both concerned by the public welfare) could successfully work together (hand in hand) to achieve this common goal. As long as it is a matter of who gets the final word and gets to influence the public, science has no chance of being heard at all, because it gets itself into a game of power where – in order to be heard – it loses already its main characteristics as a science and finds itself transformed into another authority figure of the political game.

I think the bottom of the problem is that we have no longer two separate domains: politics uses science to influence the public and even intervenes in the academic programmes to have pre-determined studies, theses and results (like a plate ordered in a restaurant=science as a menu)… and to counter-balance this usurpation, scientists ask for to speak for themselves (always to the public); why? Because, the way our academic world is made, scientists depend on the funds and grants from the government and other private institutions or individuals; this means that, in order to continue existing, science needs the financial support of the government or private individuals; this leave us with a loser loser situation:

– If science depends on the government to continue existing, then it will have to be under its authority: which means that it will no longer be a science (no integrity, among other aspects, to begin with).
– If it depends on private individuals or institutions, then it is no longer a science for the same reasons: those giving the money will order the directions and results of the work.

For all these reasons, I think the beginning of a real and long term solution would be to provide science with enough funding regardless what it is expected from it as just a way to influence the public; in other words, science needs to be free again from the authority of any other domain, so it can be science again.

This is why I am afraid I have to disagree with those who support the idea that scientists have to get into the political game so the voice of science would be heard again; I think that only means that we no longer have scientists talking to politicians but politicians talking to other politicians. In other words, that would just mean the domains of politics had completely colonized that of science.

goingfishing said,

I seriously disagree with the statement that only politicians can determine the correct way to clearly communicate a message. Well-educated citizens must have input into any public policy, if a democracy is to flourish.

Politicians in Canada and the US created Prohibition and its attendant problems, despite warnings from some citizens. The suppression of facts and conclusions based on those facts is not valid science and certainly not a valid way of governing a modern society.

I think it’s wrong to base policy solely on what ‘science’ says. Of course, it should be taken into account, but I’m wary of society turning into one in which science “has authority over all other interpretations of life, such as philosophical, religious, mythical, spiritual, or humanistic explanations, and over other fields of inquiry” (Scientism: Wikipedia). Put simply, science is great. But it should not automatically ‘trump’ all other aspects involved in the human decision making process.

janeayres said,

Comments above, about politicians having to calculate the effect of policy changes on their re-electability, hit the nail on the head. Of course this is a major consideration in policy-making. One misunderstood action, at the wrong time, can make all the difference between them being able to win another term – and thereby get a crack at implementing the whole gamut of their current policies – or not.

No one policy can therefore be taken in isolation. Its context includes timing, its priority in the list of goals the Govt hopes to achieve, and whether there are good chances of it being able to be communicated successfully across various media outlets (not just the Mail!) Remember also that on the web people are now reading whatever version of the news they prefer (or none.)

Of course the evidence, per se, should be freely and openly reported, but please don’t think that politicians only have to do what’s “right” to get re-elected, or that it doesn’t make any difference to the life chances of millions of people whether or not a Govt falls.

nel said,

Are you going to post references for this, Ben? I’d be interested to have a look at some of the research you mentioned.

I agree that the government should be looking at the evidence about this, but it seems like you’re getting social policy research/social science confused with the natural sciences. There aren’t many positivists around in the social sciences nowadays are there? And positivism’s generally associated with conservative/right wing theory in the social sciences so it’s interesting that you’re saying the opposite here. To be honest I think it’s pretty simplistic to say that it’s unproblematic to base social policy on research alone, as though it’s objective, and that this doesn’t require any interpretation. As you like to say yourself, it’s a little bit more complicated than that.

And as someone else said above, it’s not necessarily self evident what the aim of drugs policies should be. I’m not sure which policy exactly you’re referring to when you say the stated aim is to stop people taking drugs (presumably related to the classification of drugs), but in terms of substance misuse treatment, policy’s moved much more in the direction of harm reduction, rather than abstinence based treatment, in recent years. The criminal justice system doesn’t necessarily always work in a way that’s conducive to harm minimisation…but certainly some government policy isn’t just about stopping people taking drugs.

Personally, I haven’t made up my mind about whether drugs should be decriminalised. There would be any number of ways of regulating it all anyway so it’s not just a yes or no question. But if it meant drugs became more easily accessible, then I think you could probably find evidence to suggest that drug use and related harm would increase – as with the rise in alcohol-related harm as alcohol has become cheaper and more easily available (and the policies about that are a whole other story – possibly not unrelated to the influence the Portman group has in this country). That sounds paternalistic and I sort of feel uncomfortable about that, but if you look at the amount of drinking amongst people who have easy access to alcohol there does seem to be a link (e.g. Welsh mining communities where beer was subsidised by the mine owners, and people drank a lot of it, or vinyards in South Africa where workers were paid partly in wine – and rates of alcoholism are very high).

tanveer said,

The drugs problem is not an entirely scientific affair and I think it was right to sack Nutt. He is not elected and we do not want to be ruled by experts. Sure the physical effects of cannabis may not be as bad as alcohol etc. but it is also about what sort of society we want. It is not clear to me whether criminalising or decriminalising cannabis is the correct respose. In the end it does need a political judgment but Labour’s change of opininion on the matter over the years doesn’t help.

quasilobachevski said,

This is the one area on which I like what Fungus the Bogeyman Charles Clarke has to say. He advocates dividing the drugs ABC “ratings” into two – one to measure physiological “harm”, the second to measure social “harm”. Of course the second would be extremely difficult to evaluate, but it seems like a good first step towards a more honest public conversation about drugs.

Unlike many proposals (eg “legalise all drugs”) it would be politically viable – the politicians’ arses would be covered if, for instance, ecstasy were rated as class “C” for physiological harm and class “A” for social harm. But this could open the door for a downgrading of social harm later on (if it were appropriate).

@nel,

Good points. One comment, though. You said to Ben:

I think it’s pretty simplistic to say that it’s unproblematic to base social policy on research alone, as though it’s objective, and that this doesn’t require any interpretation.

Ben said:

Since every piece of research has its own imperfections … you can make your own mind up about whether you find this research compelling.

I read this as an acknowledgment that interpretation is required, but he’s not going to give it.

guthrie said,

Tanveer – Nutt was not elected but was not in any position to rule over anyone, including you, so I am a bit confused by your statement. Or is there a secret cabal of pro-drug professors actually running the country?

quasilobachevski said,

Sure the physical effects of cannabis may not be as bad as alcohol etc. but it is also about what sort of society we want.

The worry is less Labour’s flip-flopping about criminalising cannabis, and more their flip-flopping on their attitude to evidence. When he first came to office, Blair promised to implement “what works”, ie evidence-based practice.

It’s fine to say that these decisions should be made by politicians rather than scientists, but what’s the point in having an “expert committee” if they can be overruled by the editor of the Daily Mail? If this is the way it is, then surely the committee should be disbanded and the government should take responsibility for its own policies?

Richard Palmer said,

Firstly, it is, of course, ridiculous to employ someone to provide expert advice, then scweam when it isn’t what you wanted to hear.

Second, on the broader question of “harder” drugs (heroin, say) I’m sure that I read somewhere that heroin isn’t harmful in itself. That is to say, that outside of physiological and/or psychological addiction pure heroin won’t harm you.

The problems, therefore, that we see heroin addicts with tend to be associated with lifestyle or whatever crap your drugs are cut with. IN OTHER WORDS: prohibition is stupid and in doing so you are attempting to control a symptom, rather than a cause? But, hey, it’s easier to demonise thems at the bottom of the heap.

Look, Ben, it’s very simple. Scientific experiments provide you with evidence in a specific case. Guidelines require you to use intuition and ‘expert judgement’ to fill in the gaps.

For example, evidence from other countries is great, but at the end of the day it’s from other countries (and usually historic). Could it apply to the UK? Maybe, but it’s inevitably and extrapolation.

Think about medical guidelines. Although they try to be evidence based as much as possible, they cannot be in practice (I’ve spoken to several experts who are involved in medical guideline preparation). There are occasions where we can use science to provide us with a clear, unambiguous answers, but they are rare.

The job of the expert reviewer is to provide the evidence, and make clear the limitations and the gaps.

The job of the policy-maker is to take that evidence and decide policy, based on wider factors as required.

They are two different roles. They should not be confused!

Michael Gray said,

Noam Chomsky has a clarifying take on this apparent conundrum that explains why it is in politician’s favour to ignore the scientific evidence against their currently ‘irrational’ stance for, as he explains in detail, keeping the laws as they are actually favours the politicians to a very large degree.
For one, they can then instill fear into the populace: the only method by which a more educated and cynical public might actually vote for them “Law & Order!”.
Secondly, they incarcerate the ‘unproductive’ in society.
By ‘unproductive’, they mean the idle poor who smoke dope and drop Ecstasy, but not the idle rich who smoke cigars & drink scotch whisky.
The lower classes who do not repay their parliamentary ‘peers’ by committing their bodies to a lifetime of slavery in a dark satanic mill.

It makes perfect sense if you assume that a pollie wishes to retain their privilege.

Steve Halsall said,

It’s not a question of policy “filling in the gaps” where science can’t reach. There are fundamental questions that science per se simply cannot answer.

Take alcohol. Science can tell us where it sits on the scale of harm. It can tell us how much will damage us, how many people are damaged each year, what the cost is, what the associated crime is, and so on. It can tell us which programs and policies are most effective in changing (reducing) any or all of these measurements. It can also tell us whether canabis, or heroin, or nicotene, or salt, are better or worse by any of those measures. This information is absolutely invaluable in policy making, and no politician should be allowed to distort or ignore it.

But what about drawing the line? Can science answer the question, “Should alcohol be illegal?” Given all that we know about the harm that alcohol causes, and we know a lot, are we as a society still entitled to say that we want alcohol freely and cheaply available? Should a team of scientists determine the societal cost-benefit crossover point, based on some well-chosen parameters, that defines when a drug like alcohol must become illegal?

Sensible policy making should always be based on real, scientific evidence. But it must never become a slave to that evidence.

BertieWooster said,

Couldn’t disagree more. A liberal rights/ethics based approach would lead to decriminalization based on the idea that I own my own body and that should I wish to poison (or not as the case may be) myself I should be able to. This is of course subject to the usual restrictions on information and fraud in the selling of drugs (obviously input for scientists there).

Riffler said,

Not only can science give us a hard answer as to direct relative harms, there’s a growing body of evidence that prohibition simply doesn’t work – that patterns of drug use do not differ across jurisdictions depending on the penalties for possession. So just what is the point of prohibition when it can safely be said that the damage it causes outweighs the damage legalisation would probably cause?
The attitude of politicians can be summed up as “Yes, the scientific evidence all points one way, but lots of people out there are too stupid or ignorant to understand that so we’re going to do whatever we have to to avoid getting a bad headline in the Daily Mail tomorrow.”

Red Baron said,

I liked, and generally agreed with, Ben’s article – let down only by his last (and, of course, his big concluding) paragraph in which he says:-
“If you wish to justify a policy that will plainly increase the harms….” PLAINLY? Oh Ben, really! The Daily Mail needs you. I agree with you, but that’s not really the point in the context of the article.

I’m glad that Steve Halsall (29. above) raised the question of alcohol, which is one of the drugs Prof. Nutt compared cannabis with. His contribution asks “Can science answer the question, ‘Should alcohol be illegal?'”. The answer is clearly “No”, for three reasons.

The evidence of the damage done by the use of the drug is overwhelming – it is one of the world’s biggest killers, quite apart from the social costs, but that isn’t science, that is evidence which plainly (sorry, Ben, but I am not trying to justify your methodological approach) needs no detailed analysis. Alcohol is a socially damaging drug because its’ abuse, particularly by the young, is common and leads to socially undesirable and criminal behaviour. In 7% of the adult population it leads to addiction (dependency in newspeak, alcoholism in the real world) with horrendous personal and social costs. Cannabis pales into insignificance by comparison.

Reason 1 for not proscribing alcohol is that it is “socially acceptable” for historic reasons to the bulk of our society, particularly our political elite.

Reason 2 is that prohibition has been tried and has signally failed.

Reason 3 is that vested interests (and that includes the treasury) would never permit it.

This government has (lamely) introduced an Alcohol Harm Reduction Strategy, which is totally pointless because no-one, whether politician, scientist, socioligst or whatever, has a clue about what to do about it. Unfortunately they haven’t the guts to say so. It’s far easier to pontificate on cannabis and LSD, and to ignore the elephant in the room (dreadful expression – sorry).

Expert advisers advise, and policy makers should make policy taking into account that advice. Should they choose to ignore that advice they should tell us, and explain why – they might have sound reasons. If the expert advisers make undiplomatic disclosures it may be appropriate to have a quiet word, but sacking them smacks of desperation.

Jonathan said,

This is my first post – though I’ve read loads of your stuff and am a big fan.

Leaving aside your conclusions overturning a lot of accumulated government PR on drugs (not at all a bad thing in itself), aren’t you sort of answering your own question as to why the Government won’t let science advisers make their own policy –

“Since every piece of research has its own imperfections (and nobody has yet conducted a randomised controlled trial on drugs policy) you can make your own mind up about whether you find this research compelling.” (Can’t figure out block quotes as am a bit slow IT-wise, sorry)

Hasn’t pretty much our entire democratic history shown that the public and media don’t want uncertainty of outcome, or nuance or any moral equivocation. They want certainty, even if that certainty turns out to be wrong. Because a policy based upon “make up your own mind” would inevitably open a very public can of worms.

I’m thinking – within 6 months of decriminalisation a news feature pitting a mother struggling with an addicted child whose fix comes from the local chemist up against Dr Snooty Snoot the Science Minister and Drugs Tsar. The mother would mount an emotional call for tougher action to stop kids getting addicted, and for the head of her local pharmacist. Dr Snooty Snoot would then say that everyone can make up their own mind about drugs policy, quote some statistics about harm reduction and do his level best to look sympathetic. The mother would burst into tears and say that the Science Minister had her child’s life in his conscience. Science Minister is either a scientist and can offer no defence except statistics, or he’s a politician in which case he makes a tough- sounding policy pronouncement on the hoof to placate the newsroom. I’m afraid the choice here will be bad science or bad politics – the West has made its bed, drugs- wise and it will be a more educated populace than ours that allows the sheets to be changed.

jkristensen said,

Goals certainly differ. For most “drug warriors” the goal is always “a drug free world”, no matter how silly that is when put under scrutiny. As late as 1998 the UN made this their slogan despite years of discouraging experience: a drug free world – we can do it.

The really thought they could do it, y’know. Admitted, homeopathy is sillier, but they’re making a run for it.

That “no drugs” goal has caused a lot of bad things. Especially in connection with the unstated assumption that “prohibition actually works and drugs can be eliminated, it’s just a question of ….” at which time their thought processes pretty much come to a screeching halt.

Some are so gung-ho on this goal that anything behaving as if it’s impossible will be treated as if we’re talking high treason.

Sure they’ll tell you that decreased mortality and the health of drug addicts are “important”. Through their actions, however, it looks more like a eugenics program.

Water for injection is often not available, syringes restricted and/or too few and far between, and I’ve heard US drug czars argue that the heroin antidote Naloxone shouldn’t be available to addicts, because if they were actually to survive that would “send the wrong signal encouraging drug use”.

By their actions they create INCREASED harm, and they think the resulting DEATHS are a sign that the drug war is going in the right direction.

Aften Reagan rebooted the War on Drugs both Denmark (my country) and Sweden followed suite in the beginning of the 1990’s. We saw increases in drug mortality of respectively 275 and 200 per cent.

Look to the EMCDDA: they’re ALL about usage rates, while there’s hardly any comparable definition and registration of “trouble use”.

They rely almost exclusively on surrogate outcomes. That is, they do not actually measure drug use or do much about deaths and illness among the user population. No, they have these fine hypothesis, a bit like the cholesterol one, and they just measure the drug equivalent of saturated fat and jump to conclusions on how this would impact the real problem. Arrests go up: it’s a success. More people behind bars: success. Seizure of a quantity of drugs: success.

Yet they never stop to consider whether arrests attain the actual purpose of the drug policy. They don’t check if those drug dealers behind bars translates into lower usage numbers. They don’t check if those seizures actually translate into increased prices or less supply.

Unfortunately (at least in the US & I think likewise in the UK) most politicians are lawyers by training and used to making briefs for an adversarial trial. For that you pick and choose your “facts” because your adversary will do the same for their case. This is the antithesis of good science where you should draw attention to the weak points or limits of your argument and try to present a complete set of evidence for and against your hypothesis.

So naturally, they use the parts of a scientific argument that agree with their bias (for example chronic use of methamphetamine isn’t good for you) while ignoring other parts that don’t ((hard to find with Meth but here goes) the criminal activity and environmental damage involved with making ‘hillbilly heroin’ is worse).

Anyway, at my son’s school, they had a “wear red for drug control” day. Unfortunately we didn’t have the time to find a red Dupont (“better living through chemistry”) shirt. 😉 Though on second thought, given the paranoia here, it is probably good that we didn’t.

quasilobachevski said,

why would you rate ecstasy as class ‘a’ social harm? It’s social effects are actually positive – not negative.

This wasn’t a scientific suggestion, but a political one. I’m assuming (as many other posters have also suggested) that it’s politically impossible to downgrade drug harm ratings under the current system. (If you need evidence for this assumption, well, look at what happened to Prof Nutt.)

My point is that, under the system suggested by Charles Clarke, it might be politically possible to downgrade the physiological harm rating of, say, ecstasy, while maintaining the social harm rating.

There have been a lot of posts complaining about politicians meddling with scientific advice, and also lots of posts pointing out that following the scientific advice is politically impossible. Clarke’s suggestion has the unique benefit of having both some scientific merit and some political plausibility.

mikewhit said,

The Govt. has a record of ignoring academic reports when it does not coincide with its own tabloid-friendly agenda, note the last two education reviews: the Tomlinson report and the recent Cambridge Primary Review.

I find it amazing that the only media outlet any commenters here are able to name which would tend to oppose drug-law liberalisation is The Mail. The implication that it’s the lone anti-drug voice amongst the pro-drug media is less evidence-based than insane.

On the subject of decision-making, it is always worth remembering that it is a popular misconception that democracy is a good form of government because it’s a good way of making decisions. It isn’t. The efficient way of making decisions is a dictatorship. The strength of democracy is that it tends to have far more respect for civil and human rights and far less state-run violence and far lower likelihood of violent revolution than the alternatives, plus democracies hardly ever go to war against each other. That democracies tend to make bad decisions for stupid reasons via inefficient processes is a feature, not a bug, because of the end effect on society. The Framers of the US Constitution understood this so well that they deliberately engineered their system to be even less efficient.

It must be exasperating to be a government advisor (scientific or otherwise) and to regularly have your extremely good advice not followed. But, while it may look like a Bad Thing, it is in fact a side-effect of a Good Thing.

If it were a subject on which opinion varied widely across the media, that’d be a good point. But, on drug-law liberalisation, to name The Mail and no other media outlet is a seriously misleading representation of journalistic opinion, which in turn causes some rather fuzzy thinking. For example:

smowton said,
November 7, 2009 at 2:40 am

The odd thing is, suppose a Labour government said to hell with it, let’s legalise the less harmful drugs (cannabis, ecstasy, LSD, …) and tax the resulting industries to pay for the inevitable casualties, like we do with tobacco and alcohol. Then the Daily Mail would certainly stir up a storm, but how many Daily Mail readers were Labour voters to begin with? And after the storm wears off, how much lasting impact will it really have? In short, should they really care?

By contrast a Conservative government would have much to fear from reasonable evidence-based drugs policy, as their voters are to some degree Mail readers, so the window for admitting reason is unfortunately closing.

Smowton seriously seems to think that Labour-voters are broadly for drug-law liberalisation and that media outlets other than The Mail wouldn’t much protest if a government tried it. This belief is simply not based on any recent realistic observation of the UK.

quasilobachevski said,

That’s a very reasonable criticism of smowton’s argument. I don’t think this invalidates the use of the Mail as an example (and I think you’ll find, if you look at the comments above, that most posters have used it as no more than that) – but you’re right to point out that it is just an example.

thinkerhead said,

Professor Nutt certainly has good cause for believing that legalization followed by taxation and supply through licensed, state monitored channels could lead to reduction of harm through use/abuse of many substances.

What he has misunderstood is the purpose of scientific advice to government ministers. There is little evidence that this is intended to provide rational guidance on policies to improve the welfare of the electorate.

It seems probable that its purpose is to improve the prospects of a parliamentary majority at the date of the next election. This purpose is not best served if the advice is:
a)seen to come from someone other than a minister, or
b)so obviously right that its difficult to understand why its not done already, or
c)unlikely to have worked by the time of the next election.

Professor Nutt may not be a politician but I’d vote for him.

paul8032 said,

If you haven’t read the Joanna Blythman article from the Sunday Herald (flagged up in the mini-blog) you really should. This is such a superstitious, factually-confused, anti-science piece of twaddle it really goes straight to ante-post faourite in the Bad Science Awards 2009.
If I were a cultural relativist I would be embarrassed.

Caledonian1976 said,

“but I’m wary of society turning into one in which science “has authority over all other interpretations of life, such as philosophical, religious, mythical, spiritual, or humanistic explanations, and over other fields of inquiry””

Such a shame science doesn’t have total authority over religious, mythical and spiritual “explanations” or “fields of inquiry” (a misnomer, if ever there was one).

daven said,

There is a question not yet asked, “Are Ministers and Permanent Secretaries qualified to make decisions in the 21st century when they have no understanding of the scientific evaluation of uncertain evidence?”.

In a technological age, this has become an essential requirement for decision-makers. We see that such expertise is deliberately brought in to the boards of private companies, and in the French civil service: so why are UK Ministers and Permanent Secretaries required to sit examinations to prove their competence to govern?

quasilobachevski said,

I’m sure that I read somewhere that heroin isn’t harmful in itself. That is to say, that outside of physiological and/or psychological addiction pure heroin won’t harm you.

I read something similar – people who are addicted to heroin can apparently lead a relatively normal life if it is provided for them in specific quantities. However apart from the problems you mention, blackmarket heroin is of unknown purity to the end-user, who may fatally overdose if they get something which is stronger than usual.

Red Baron wrote:

It’s far easier to pontificate on cannabis and LSD, and to ignore the elephant in the room (dreadful expression – sorry).

skyesteve said,

irishaxeman said,

Anyone with half a brain knows that alcohol is the most utilised drug and by any method the most costly and damaging to society. Most cases that come before the magistrates courts after a weekend involve drink influenced behaviour. It is the rocket fuel of assaults. It is, apart from power, the preferred drug of politicians.

I have absolutely no faith in politicians since I was deeply involved in local and national politics in the 1970s and 80s. I walked away in disgust after some twenty plus years having encountered in all parties the most venal, fraudulent and ignorant people, virtually none of them fit to go an errand to the corner shop, let alone run a country. Ex-student politicians such as Clarke and Straw were amongst the worst, Straw being primus inter pares.

Very few elected politicians have any real experience of life as most of us know it, and even if they have, the posturing and dissembling they indulge in to ascend the political ladder divorces them from ordinary realities.

My wife is always amused when I let fly at the TV with some ripe insult or anecdote, usually prefaced by ‘bloody life-long liar’ or some such.

Terry Hamblin said,

Unlike many of your correspondents I have not tried most of the drugs referred to, apart from alcohol, and I am not very keen on that. If I want my mind stimulated I read a good book.

In trying to assess physical harm, it took a very long time to detect the harm done by tobacco, and very few believed it when there was clear scientific evidence for it. I doubt very much whether other drugs have had the same scrutiny applied to them.

The harm that alcohol does is plain for all to see. Prohibition in America did not prevent it from harming people, but neither has the subsequent policy of allowing it to be a licensed drug. When a drug is illegal, criminals make a lot of money by supplying it and addicts commit crimes to obtain it. At least legalising it reduces this, though not completely – eg the white vans being ferried to Calais and returning with far more than can legitimately be for ‘personal use’.

Education and propaganda, together with price increases, have reduced the proportion of the population smoking tobacco, but it is still a substantial proportion. We really have no idea how prevalent the use of drugs is for the simple reason that people lie when asked – either out of guilt or bravado.

I would welcome a good study on the harm caused by drugs, but I doubt that it will be possible. We know that 20 years of tobacco smoking leads to lung cancer; what population base could you use to find a long term study of cannabis use, and how would you disentangle the effect from that of other drugs?

One could, of course, adopt the libertarian view that what someone does to their own body is his/her own affair, but while we have the NHS everybody has to pay for that indulgence. Furthermore, the social harm done may impact on all of us. Few drugs do as much social harm as alcohol, but is someone fit to drive under the influence of cannabis? How would one masure what is a safe level? How about cannabis plus another drug? Would we have to resort to devices that measure reaction time?

My point in arguing like this is to stress that there is not a simple scientific answer. Having spent 30 years as a scientist I have come to realise that the scientific method is useful for answering a well-formulated question, but unless a good question can be formulated it can lead investigators into a jungle. Scientists often know an awful lot about very little. My knowledge of astrophysics is probably no better than Alan Johnson’s but get me on chronic lymphocytic leukemia and I could wipe the floor with Professor Nutt. Only some of my genius is transferable to other fields.

Could Nutt, in theory, argue succesfully that his “belief” in science means that he was discriminated against?

Obviously no-one really wants this, for the simple reason that science is not religion and should not be treated like religion – but here are two people whose cases kind of drive home the point that the protected status of religion is kind of a problem in a democracy.

A lot of people in Britain are firm believers in allmighty Argos, for whom there is a lot more evidence than any other contemprorary deities. You say your prayer to one of the priests or priestesses in the holy temple, make a small offering of a size appropriate to the size of your prayer and lo, you will be heeded. I myself once succesfully prayed for a bean bag, and two weeks later – there it was, delivered to my door. His earthly appointed wore blue and cursed my stairs.

Can I argue that as a member of Church of Argos, I have to get special time off to observe the holy deliveries?

I am torn though, because Church of Tesco delivers food as well, but tends to demand larger offerings. Swings and roundabouts I guess.

TD said,

Terry, you “would welcome a good study on the harm caused by drugs” – what about a study of the risks associated with prohibition, too? Surely only by weighing up the pros and cons of legalisation, regulation and prohibition, can we come to a reasonable drugs policy?

There appears to be very little research on the risks associated with prohibition.

elvisionary said,

It may seem a bit odd on the bad science website to fall back on anecdote and “folk wisdom”, but it strikes me that we could benefit from listening to the views of the many people in the population who have experience of cannabis, either through their own use or the use of others they know.

Cannabis is something of a rite of passage for many young people – taken sociably, in relative moderation. Most of these social, moderate users revert gradually to alcohol as their preferred drug – and not just because of legality, but because they enjoy alcohol more. It’s only a fairly small minority who use cannabis very regularly, and continue for many years – and most people believe that those who do will ultimately do damage to their brains. Ask any student, and they’ll give you an anecdote about someone who’s fried their brains through overuse, and have suffered psychological problems. Therefore many students and ex-students will believe, quite consistently, that the classification of cannabis is over the top (because it was fundamentally harmless for them), but at the same time that it can be dangerous in excess.

In other words, the folk wisdom is probably that both Professor Nutt and his critics (who’ve pointed to risks of schizophrenia etc.) are correct in some respect. You can argue, therefore, that public policy can not rest purely on the science, but will ultimately depend on how much you want to infringe the rights of the majority by protecting the minority from themselves. Or, to put it another way, how nannyist you want to be. Yes, the same argument can be applied to alcohol – but the dividing line is different there because alcohol is so culturally ubiquitous that any prohibition would be more aggressively nannyist.

mikewhit said,

ChrisRoberts said,

There is a fundamental incongruity right at the heart of drugs policy: the government wants to accrue the cachet of scientific expertise for decisions which are purely political and pragmatic. So the populace is supposed to believe that the government is legalising or criminalising their actions on the basis of presumptions about harm, while knowing full well that they are barely based on that at all. Drugs policy seems to be largely based around the trends of most media outlets that basically perpetuate the “fears” about drugs without ever dealing with the wider social context. On last week’s Question Time a perfect distillation of this was present. All the panellists were feigning disagreement but all ended up saying similar things, namely that “drugs kill” Almost all the experts agree that it is the illegality of drugs that contribute most to this “killing” because the quality is inconsistent – drugs mixed with brick dust and powdered soap etc – and the fact that in order to obtain the ‘products’ one has to enter an underground and potentially dangerous world. This, as far as I can ascertain, is the general trend of drugs advisory panels and was the kind of advice given to the Govt on the issue. That they chose, not only to ignore the advice, but went further and sacked the chief scientist responsible for researching and communicating this advice, ably demonstrates that governments are not particularly interested in expert advice. That is unless of course this advice offers a series of populist “easy answers”. These “easy answers” are anything but actual answers, they are instead knee jerk, short termist soundbites that are perfectly palatable to a media with little or no interest in wider contextual analysis. In the end nothing will change precisely because the needs of politicians will always take precedence over and above the needs of those addicted to drugs.

skyesteve said,

@elvisionary – “Yes, the same argument can be applied to alcohol – but the dividing line is different there because alcohol is so culturally ubiquitous”
And cannabis isn’t? Speaking from my anecdotal, non-user status cannabis looks pretty ubiquitous to me in the under 40s at least…

Terry Hamblin said,

TD: The risks of prohibition are well-aired. I fully accept them, but the risks of regulation and taxation of alcohol are all too apparent. Apart the removal of criminality, is society any better off by allowing alcohol to be available so freely? Wife-beating, road accidents, date-rape, assault, manslaughter, family breakdown, child neglect and poverty can all be attributed to ethanol. Perhaps the duty on booze does pay for the NHS, but I doubt that it funds the other consequences.

Those arguing for a change in status for other drugs must demonstrate that things would be better if they were freely available. I just don’t think that the evidence is at hand. It’s not enough to argue that it would be beneficial to take them out of the hands of criminals, though I agree that would be a benefit.

Look how long it took to establish the harm caused by tobacco and look how long it took before most people accepted the fact. We are decades away from having that sort of information on cannabis or ecstasy, let alone the newer formulations.

quasilobachevski said,

elvisionary said,

@skyesteve – agree, but it’s a question of degree. Alcohol is central to the culture, used by most of the adult population on most days an ingredient of most social interaction. Most people – even the under 40s – encounter cannabis less frequently, and might not even notice if it didn’t exist.

On prohibition, when I was younger I went to school in the US for a short spell. (No, this wasn’t in the 1930s – I’m talking about the legal drinking age!). It was difficult for teenagers to get hold of alcohol, in stark contrast to the UK. The result was that cannabis was far more widely used than in the UK – virtually every teenager smoked weed. (The other result was that people became very good at forging driving licences). Young people need their escapes and vices, so perhaps the question for public policy is which poison you’d prefer our young people to be enjoying.

@Terry Hamblin, to most of us the clear harm done by tobacco doesn’t mean it should be illegal. This is a fundamental point of liberal principle. I believe the same about alcohol, which may be responsible for many of the things you describe, but is also responsible for a huge amount of pleasure and enjoyment. Should those who enjoy alcohol in moderation and behave responsibly be punished for the actions of a minority of morons? But the “harder” that drugs become, the more difficult this question becomes.

skyesteve said,

@elvisionary – you’re right about alcohol and cannabis (and I was being a wee bit facetious – sorry).
But to me there is also a difference between alcohol and tobacco. In addition not all “illegal” drugs are the same.
As you point out alcohol is not the problem – it’s the misuse of alcohol that’s the problem. But alcohol used infrequently and in moderation has no real short or long-term health problems and has some definite social and psycho-social benefits. It may even be good for your heart (although that idea seems to go in and out of fashion somewhat).
In contrast there is no safe smoking level and even one fag a day increases your risk of significant pathology. This is also an issue with cannabis since, as far as I understand (having never done it myself), cannabis is mixed with tobacco for smoking.
Opiates could in theory be safe and enjoyable if used in purified form, in small amounts and in a safe environment. They are also starnge drugs in that whether or not you get a buzz from them depends to some extent on the circumstances in which they are used.
In contrast, there is some evidence to suggest that even a single use of cocaine can result in permanent structural brain changes.
The whole thing really is a messy business when you stop to think about it!

TD said,

I’m a fan of John Stuart Mill when it comes to the proper limits of the exercise of power over others. ‘Society’ isn’t, ‘it’ thinks it is appropriate and right to interfere with our freedoms – well, I think it’s wrong but that’s where we are! But surely, if we are to interfere, then any interference should be based on evidence, a weighing up of the pros and cons, a cost-benefit analysis? Apparently there has been no such weighing up. You say the risks of prohibition have been “well aired”, but have they been well researched, and debated in Parliament?

(Incidentally I think it’s pretty difficult for a non-technical person to find out the risks associated with consuming illegal drugs. Talk to Frank for example isn’t particularly clear.)

skyesteve said,

@TD – Nick Davies’ article is good but I think he needs to spend more time working with drug users me thinks.
“Street buyers cannot afford to waste any heroin – and for that reason, they start to inject it, because smoking or snorting it is inefficient” – that’s not why street heroin users chose to inject or smoke or otherwise. In fact the effect is more rapid with smoking and that is certainly the preferred route in my part of the world (and the choice of route has as much to do with peer pressure and the current “drug culture” as any worries about limited supplies or blood borne virus infections).
But otherwise a good article with some sensible comment.

Soarhead said,

It’s about time that the whole concept of our approach to drugs got the “Bad Science” treatment. Never forget that the very existence of the ACMD is a function of the Misuse of Drugs Act 1971. In several hundred years time with the 20-20 view that history gives this may come to be seen as the worst error the British government ever made.

Dr Spouse said,

Although I am in complete agreement with both a) the need to look at research on prohibition/legalisation for the real answer and b) the shocking nature of the whole affair, I can’t help feeling Nutt has shot himself in the foot rather with failing to understand that “risk” is not the same as “probability”. Unfortunately medical, physical and biological scientists have a habit of forgetting that there exist behavioural scientists who have studied things like people’s perception of risk.

Telling us that “horse-riding is more risky than taking cannabis” is not helpful. It is possible that the probability of death or serious disability is greater (I’m not quite sure which he was referring to), or the average reduction in DALYs for habitual horse-riders versus habitual cannabis users is greater, but the RISK, which is a subjective, perceptual concept is probably not greater – and it makes him look a bit misinformed to say that.

adamk said,

Surely , from an ethical point of view , we should let properly informed , competent people make the choice for themselves , as to whether they take any drug , or not – as long as it causes no harm to others.

The same argument could be made against the law about forcing us to wear seat belts.

by the way @skysteve – you can eat cannabis too! (and possibly even stick it up your bum!), so tobacco consumption is not necessarily involved.

I’m not wholly pleased with myself as I decided to do it in a hissy fit, but I feel I need to follow it through now.
It’s at quantsuff.wordpress.com/. I’d be very grateful if you’d have a look and make any comments for me.
Sorry to hijack Ben’s blog for what amounts to self-promotion, but I have mention Bad Science on there to salve my conscience.

quasilobachevski said,

… but the RISK, which is a subjective, perceptual concept is probably not greater – and it makes him look a bit misinformed to say that.

First, I should admit that I haven’t read Nutt’s article. But I think you’ve completely misunderstood his intention in comparing horse riding and ecstasy: viz, to highlight the different ways we think about the risks of different activities. As I understood it, his thesis was that there are certain biases in the way we think about drug-taking, compared to other risky activities, which prevent us from having an honest public debate. In other words, the purpose of the article was to contrast risk and probability, as you define them.